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Khouzam Rami N RN Department of Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, - - 2014
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiac disease. Patients may present with a wide variety of symptoms, ranging from relatively asymptomatic to heart failure, recurrent syncope, angina, or sudden death. Once diagnosed, a thorough clinical, anatomic and physiologic assessment should be undertaken. Treatment options include both pharmacologic and ...
Panovsky Roman R From the *Department of Cardiovascular Diseases, International Clinical Research Center, St. Anne's Faculty Hospital and Masaryk University, Brno, Czech Republic; †Department of Interventional Radiology, Hospital Trinec-Podlesi, Trinec, Czech Republic; ‡Department of Medical Imaging, St. Anne's Hospital, Masaryk University, Brno, Czech Republic; and §Institute of Normal and Pathological Physiology and Center of Excellence for Regulatory Role of Nitric Oxide in Civilization Diseases, Slovak Academy of Sciences, Bratislava, Slovak - - 2014
Cardiovascular magnetic resonance using late gadolinium enhancement (LGE) provides a unique opportunity to assess myocardial tissue in vivo. LGE enables tissue characterization in ischemic and nonischemic cardiomyopathies and other cardiac diseases. LGE is associated with adverse clinical outcomes across a range of different cardiac conditions and may improve risk stratification ...
Mao Song Shou SS Los Angeles Biomedical Research Institute at Harbor-UCLA, 1124 West Carson St, Torrance, CA - - 2014
The cardiac chamber volumes and functions can be assessed manually and automatically using the current computed tomography (CT) workstation system. We aimed to evaluate the accuracy and precision and to establish the reference values for both segmentation methods using cardiac CT angiography (CTA). A total of 134 subjects (mean age ...
Waller Alfonso H AH Non-Invasive Cardiovascular Imaging Program, Department of Medicine (Cardiovascular Division) and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, - - 2014
The noninvasive detection of the presence and functional significance of coronary artery stenosis is important in the diagnosis, risk assessment, and management of patients with known or suspected coronary artery disease. Quantitative assessment of myocardial perfusion can provide an objective and reproducible estimate of myocardial ischemia and risk prediction. Positron ...
Padeletti Margherita M aDepartment of Cardiovascular Diseases, University of Siena, Siena, Italy bDivision of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, - - 2014
Sleep-disordered breathing (SDB) has been consistently associated with increased risk for cardiovascular diseases, including arrhythmias. The purpose of this review is to elucidate the several pathophysiologic pathways such as repetitive hypoxia and reoxygenation, increased oxidative stress, inflammation and sympathetic activation that may underlie the increased incidence of arrhythmias in SDB ...
Kuijpers Nico H L NH Maastricht - - 2014
It is not understood why after onset of left bundle-branch block (LBBB), acute worsening of cardiac function is followed by a further gradual deterioration of function, while most adverse cardiac events lead to compensatory adaptations. We investigated whether mechano-electrical coupling (MEC) can explain long-term remodeling with LBBB and cardiac resynchronization ...
Hisatomi Kazuki K Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan, - - 2014
Accessory mitral valve (AMV) tissue is a congenital anomaly that occurs in association with other congenital anomalies, and is an uncommon cause of left ventricular outflow tract obstruction. It is usually detected in early childhood when accompanied by symptoms of obstruction of the left ventricular outflow tract, and is rarely ...
Halbreiner M Scott MS Cleveland Clinic Foundation, Thoracic and Cardiovascular Surgery, Cleveland, OH - - 2014
Heart failure remains one of the most prevalent diseases worldwide and in recent decades, left ventricular assist devices (LVADs) have become an important treatment option. With increasing device experience, there is particular interest in the use of LVADs as a bridge to recovery that allows the patient's heart to undergo ...
Lauritzen M H - - 2014
Several diseases of the heart have been linked to an insufficient ability to generate enough energy (ATP) to sustain proper heart function. Hyperpolarized magnetic resonance (MR) is a novel technique that can visualize and quantify myocardial energy metabolism. Hyperpolarization enhances the MRsignal from a biological molecule of interest by more ...
Wang Wenjuan W Shandong University Qilu Hospital Research Center for Cell Therapy, Key Laboratory of Cardiovascular Remodeling and Function Research, Qilu Hospital of Shandong University, Jinan 250012, China; Department of Cell Biology and Anatomy, University of South Carolina, SC 29208, - - 2014
Nuclear factor erythroid-2 related factor 2 (Nrf2) is a master transcription factor that controls the basal and inducible expression of a battery of antioxidant genes and other cytoprotective phase II detoxifying enzymes. While knockout of Nrf2 exaggerates cardiac pathological remodeling and dysfunction in diverse pathological settings, pharmacological activation of Nrf2 ...
Fujiwara Takayuki T Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya Ward, Saitama, Saitama, 330-8503, - - 2014
Dipeptidyl peptidase-4 (DPP4) is an integral membrane glycoprotein that modulates the pathological state of diabetes mellitus (DM), and DPP4 inhibitors are a new class of anti-type-2 DM drugs. Recent preclinical studies have associated DPP4 inhibition with improved myocardial systolic and diastolic function. Based on preclinical findings, we investigated associations between ...
Miwa Kunihisa K Department of Internal Medicine, Miwa Naika Clinic, 1-4-3 Shintomicho, Toyama, 930-0002, Japan, - - 2014
The etiology of chronic fatigue syndrome (CFS) is unknown. Myalgic encephalomyelitis (ME) has been recently postulated to be the cause of CFS. Orthostatic intolerance (OI) has been known as an important symptom in predicting quality of life in CFS patients. Cardiac function may be impaired in patients with ME. The ...
Guo Wen-Ting WT Department of Pharmacology (the State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), Harbin Medical University, Baojian Road 157, Harbin, 150086, Heilongjiang Province, People's Republic of - - 2014
Bone morphogenetic protein-4 (BMP4) is a member of the bone morphogenetic protein family which plays a key role in the bone formation and embryonic development. In addition to these predominate and well-studied effects, the growing evidences highlight BMP4 as an important factor in cardiovascular diseases, such as hypertension, pulmonary hypertension ...
Laffin Luke J LJ University of Chicago, Department of - - 2014
The recent work by Carbone et al. using inferior vena cava (IVC) parameters to predict re-admission in ischaemic heart failure (1) adds to the increasing evidence in favour of the use of focused cardiac ultrasound, in addition to physical examination and serum biomarkers, to guide treatment of acute decompensated heart failure ...
Carbone Federico F Department of Internal Medicine, University of Genoa School of Medicine, IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, 6 vilae Benedetto XV, 16132, Genoa, Italy; Division of Cardiology, Foundation for Medical Researches, Department of Medical Specialties, University of Geneva, 64 avenue de la Roseraie, 1211 Geneva, - - 2014
We would thank Dr. Laffin since his letter entitled "Precipitants of heart failure must be fully considered when predicting readmission" constructively commented on our "pilot" study by providing interesting issues, as also recently published by his group [1]. At present, the inferior vena cava (IVC) assessment is widely considered as ...
Alapati Lavanya L Lavanya Alapati, W Randolph Chitwood, John Cahill, Sanjay Mehra, Assad Movahed, Department of Cardiovascular Sciences, East Carolina University, Brody School of Medicine, East Carolina Heart Institute, Greenville, NC 27834, United - - 2014
Left ventricular (LV) pseudoaneurysm is a rare complication that is reported in less than 0.1% of all patients with myocardial infarction. It is the result of cardiac rupture contained by the pericardium and is characterized by the absence of myocardial tissue in its wall unlike true aneurysm which involves full ...
Doyen Denis D Medical Intensive Care Unit, Archet I University Hospital, 151 Route Saint Antoine de Ginestière, 06200 Nice, France. Electronic address: - - 2014
We report the case of a middle age patient presenting with Tako-Tsubo cardiomyopathy (TTC) complicated by cardiogenic shock that was successfully handled with milrinone. A 64-year old man presented with cardiogenic shock after benzodiazepine and alcohol intoxication. A slight elevation of troponin and typical left ventricular ballooning without coronary lesions ...
Mao Yuanjie Y Department of Biochemistry, National Cerebral and Cardiovascular Center, Suita, Osaka 565-8565, Japan. Electronic address: - - 2014
Both hexarelin and its natural analog ghrelin exert comparable cardioprotective activities. A single dose of ghrelin administered at the very acute phase after experimental myocardial infarction positively affects cardiac function in chronic heart failure. Therefore, this study aimed to determine whether a single dose of oral hexarelin has the same ...
Coutinho Danielle C O DC Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Av. Antônio Carlos, 6627-31.270-901, Belo Horizonte, MG, - - 2014
Diabetic patients present a high level of cardiac arrhythmias and risk of cardiac sudden death. The renin-angiotensin system (RAS) plays a key role in diabetes and cardiac diseases. The present study aimed to evaluate whether an angiotensin-converting enzyme 2 (ACE2) activator, diminazene aceturate (DIZE), could improve the streptozotocin (STZ)-induced electrical ...
Maass Saskia W M C SW Department of Intensive Care, Maastricht University Medical Centre, Maastricht, Netherlands. Electronic address: - - 2014
The aim of the present study was to compare 2 noninvasive cardiac output measurement methods with the continuous cardiac output thermodilution (CCO-TD) method. A single-center prospective design. A university hospital. Fifty-three consecutive patients scheduled for elective, non-emergent cardiac surgery. With each participant the cardiac output was measured using 3 methods: ...
Swain Jabaris D JD Department of Surgery, Division of Cardiac Surgery, Brigham and Women's Hospital-Harvard Medical School, Boston, MA, USA, - - 2014
Rheumatic heart disease (RHD) in the developing world results in critical disability among children, adolescents, and young adults-marginalizing a key population at its peak age of productivity. Few regions in sub-Saharan Africa have independently created an effective strategy to detect and treat streptococcal infection and mitigate its progression to RHD. ...
McMullan V V Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, - - 2014
Since its inception, administering and ensuring anaesthesia during cardiopulmonary bypass has been challenging. Partly because of the difficulty of administering volatile agents during cardiopulmonary bypass, total intravenous anaesthesia has been a popular technique used by cardiac anaesthetists in the last two decades. However, the possibility that volatile agents reduce mortality ...
Mailloux Ryan J RJ University of Ottawa, - - 2014
Glutaredoxin-2 (Grx2) modulates the activity of several mitochondrial proteins in cardiac tissue by catalyzing deglutathionylation reactions. However, it remains uncertain if Grx2 is required to control mitochondrial ATP output in heart. Here, we report that Grx2 plays a vital role modulating mitochondrial energetics and heart physiology by mediating the deglutathionylation ...
Chen Chan C Department of Anesthesiology, West China Hospital, Chengdu, - - 2014
Cardiac myxoma arising form right ventricular outflow tract (RVOT) is extremely rare, but could cause major clinical sequelae and pose considerable diagnostic and therapeutic challenges. Here, we report the intraoperative application of real time three-dimensional transesophageal echocardiography (RT3DTEE) in the assessment of a patient with a RVOT myxoma. RT3DTEE clearly ...
Lalit Pratik A PA From the Department of Medicine (P.A.L., A.N.R., T.J.K.), Molecular and Cellular Pharmacology Program (P.A.L., T.J.K.), and Stem Cell and Regenerative Medicine Center (P.A.L., D.J.H., A.N.R., T.J.K.), Waisman Biomanufacturing at University of Wisconsin, Madison - - 2014
Coronary artery disease with associated myocardial infarction continues to be a major cause of death and morbidity around the world, despite significant advances in therapy. Patients who have large myocardial infarctions are at highest risk for progressive heart failure and death, and cell-based therapies offer new hope for these patients. ...
Ermis Peter P Department of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex, - - 2014
This article aims to give a comprehensive description of cardiac resource utilization in adults at a freestanding children's hospital. Retrospective chart review. Large, tertiary, freestanding children's hospital. Adults (18 years of age and older) seen within the heart center or evaluated by heart center personnel from January 1, 2006 through ...
Maisch Bernhard B Medical Faculty of Philipps University Marburg and Cardiovascular Center Marburg, Erlenring 19, 35037, Marburg, Germany, - - 2014
Fulminant myocarditis is a clinical syndrome with signs of acute heart failure, cardiogenic shock, or life-threating rhythm disturbances in the context of suspected myocarditis. It is not an etiological diagnosis, but may have different underlying causes and pathogenetic processes - viral, bacterial, toxic, and autoreactive. Clinical management of the disease ...
Staab W W Institute for Diagnostic and Interventional Radiology, University Medical Center of Georg-August-University, - - 2014
Purpose: Evaluation of a new cardiac MDCT protocol using a split-bolus contrast injection protocol and single MDCT scan for reliable diagnosis of LA/LAA thrombi in comparison to TEE, optimizing radiation exposure and use of contrast agent. Materials and Methods: A total of 182 consecutive patients with drug refractory AF scheduled ...
Polasek Rostislav R Department of Cardiology, Regional Hospital Liberec, Husova 10, Liberec, Czech - - 2014
Cardiac resynchronization (CRT) is the established therapy of chronic systolic heart failure in patients with intraventricular conduction delay - wide QRS complex. Approximately 30% of patients, however, do not respond to this therapy clinically; and in 50% of patients, CRT is not associated with LV reverse remodeling. This article is ...
Pitt Bertram B From the University of Michigan School of Medicine, Ann Arbor (B.P.); the Cardiovascular Division, Brigham and Women's Hospital, Boston (M.A.P., B.C., A.S.D., E.F.L., S.D.S.); New England Research Institutes, Watertown, MA (S.F.A., B.H., C.T.K., S.M.M.); National Heart, Lung, and Blood Institute, Bethesda, MD (R.B., J.L.F., S.Y.); Veterans Affairs Medical Center and University of Minnesota, Minneapolis (I.S.A.); Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil (N.C.); Estudios Clinicos Latinoamerica, Rosario, Argentina (R.D.); Pirogov Russian National Research Medical University, Moscow (I.G.); New York Methodist Hospital, Brooklyn (J.F.H.); Montreal Heart Institute, Montreal (E.O.); University of Washington Medical Center, Seattle (J.L.P.); Diagnostic Services Clinic, Tbilisi, Georgia (T.S.); Northwestern University, Chicago (S.J.S.); and the University of Wisconsin, Madison - - 2014
Mineralocorticoid-receptor antagonists improve the prognosis for patients with heart failure and a reduced left ventricular ejection fraction. We evaluated the effects of spironolactone in patients with heart failure and a preserved left ventricular ejection fraction. In this randomized, double-blind trial, we assigned 3445 patients with symptomatic heart failure and a ...
Andò Giuseppe G Department of Clinical and Experimental Medicine, Cardiology Section, Policlinico "G. Martino", University of Messina, Messina, - - 2014
Diagnostic criteria for Takotsubo cardiomyopathy (TTC) still remains a matter of debate. The similarities between cardiac dysfunction which complicates cerebrovascular events and 'typical' TTC let us hypothesize that the current diagnostic criteria of TTC need to be widened. Moreover, clinical, histological and scintigraphic similarities have been robustly reported between TTC ...
Bian Weining - - 2014
The ability to control the degree of structural and functional anisotropy in 3D engineered cardiac tissues would have high utility for both in vitro studies of cardiac muscle physiology and pathology as well as potential tissue engineering therapies for myocardial infarction. Here, we applied a high aspect ratio soft lithography ...
Rojek A A Department of Cardiology, Wroclaw Medical University, Wroclaw, - - 2014
The Gly482Ser polymorphism in the peroxisome proliferator-activated receptor gamma coactivator-1α (PPARGC1A) has been reported to contribute to the development of left ventricular (LV) hypertrophy. Little is known, however, about its possible impact on cardiac dysfunction. Enhanced myocardial fibrosis accompanying increased LV mass might represent a link with coexisting functional abnormalities. ...
Lindholm E E EE Department of Anaesthesiology, Vestfold Hospital Trust, Tønsberg, - - 2014
The aim of this study was to define pre-operative echocardiographic data and explore if postoperative indices of cardiac function after open abdominal aortic surgery were affected by the anaesthetic regimen. We hypothesised that volatile anaesthesia would improve indices of cardiac function compared with total intravenous anaesthesia. Transthoracic echocardiography was performed ...
Weisser-Thomas Jutta J Department of Cardiology and *Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53105 Bonn, Germany and #Department of Medicine (Cardiovascular Medicine), University of Pennsylvania Medical Center and Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, - - 2014
Objectives Cardiac magnetic resonance (CMR) identifies the substrate of ventricular arrhythmia (VA) in cardiomyopathies and coronary heart disease. However, little is known about the value of CMR in patients with VA without previously known cardiac disorders. Methods 76 patients with VA without known cardiac disease after regular diagnostic work-up were ...
Weir Robin Ap RA Consultant Cardiologist, Cardiology Department, Hairmyres Hospital, Lanarkshire, Scotland, - - 2014
Dilated cardiomyopathy (DCM) is a common cause of heart failure. The underlying aetiology remains poorly characterised, with ca. 50% labelled 'idiopathic'. We assessed the extent to which the aetiology of DCM is investigated in Scotland, in comparison to European Society of Cardiology (ESC) recommendations. Questionnaires regarding the use of coronary ...
Bonetti Monica M Hubrecht Institute-KNAW and University Medical Center Utrecht, Utrecht 3584 CT, The - - 2014
Germline mutations in PTPN11, encoding Shp2, cause Noonan syndrome (NS) and LEOPARD syndrome (LS), two developmental disorders that are characterized by multiple overlapping symptoms. Interestingly, Shp2 catalytic activity is enhanced by NS mutations and reduced by LS mutations. Defective cardiac development is a prominent symptom of both NS and LS, ...
Jia Zhi-Bo ZB Department of Cardiovascular Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, - - 2014
Extracellular matrix (ECM) remodelling is a critical aspect of cardiac remodelling following myocardial infarction. Tissue inhibitors of metalloproteinases (TIMPs) are physiological inhibitors of matrix metalloproteinases (MMPs) that degrade the ECM proteins. TIMP-3 is highly expressed in the heart and is markedly downregulated in patients with ischemic cardiomyopathy. Cell-based gene therapy ...
Yoda Shunichi S Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan. Electronic address: - - 2014
There are no reports indicating that automated quantification with a total perfusion deficit (TPD) is used to predict future cardiac events in Japanese patients. We, therefore, aimed to determine the prognostic value of the automated assessment with the TPD for risk stratification of major cardiac events (MCEs) in Japanese patients ...
Knackstedt C C Department of Cardiology, Maastricht University Medical Center, Maastricht,The Netherlands - - - 2014
There is a longstanding debate over the longterm effect of intensive endurance training on cardiac function. Usually, echocardiography has been used as a global evaluation of left ventricular (LV) or right ventricular (RV) function and dimensions. Recently, speckle tracking strain (ST) has provided an analysis of regional RV and LV ...
Zitta Karina - - 2014
Transient episodes of ischemia in a remote organ or tissue (remote ischemic preconditioning, RIPC) can attenuate myocardial injury. Myocardial damage is associated with tissue remodeling and the matrix metalloproteinases 2 and 9 (MMP-2/9) are crucially involved in these events. Here we investigated the effects of RIPC on the activities of ...
Alp Hayrullah H aDepartment of Pediatric Cardiology, Malatya State Hospital, Malatya bDepartment of Pediatric Cardiology, Necmettin Erbakan University, Meram School of Medicine Hospital cDepartment of Pediatric Endocrinology, Necmettin Erbakan University, Meram School of Medicine Hospital, Konya, - - 2014
Obesity and hypertension are associated with structural and functional cardiac change in children and adults. The aim of the study is to evaluate the effect of hypertension and obesity on left ventricular geometric patterns and cardiac functions assessed by conventional and Doppler echocardiography. Four hundred and thirty obese children, aged ...
Eastwood Glenn M GM aDepartment of Intensive Care, Austin Hospital, Heidelberg, Melbourne, Victoria, Australia bIntensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand cAustralian and New Zealand Intensive Care Research Centre, Melbourne, Victoria, - - 2014
To describe the impact of oxygen and carbon dioxide management on patient outcomes following cardiac arrest. Although there are no data that suggest that supplemental oxygen administration during cardiopulmonary resuscitation is harmful, there is concern that 100% oxygen during the postresuscitation phase may be undesirable. The evidence to avoid hyperoxia ...
Myung Lee Jung J Division of Cardiology, Cardiovascular Center, Yonsei University College of Medicine, Seoul, - - 2014
Prolongation of the QTc interval on 12-lead ECG is related to total mortality and sudden cardiac death. The value of the paced QTc in predicting mortality has not been investigated. To evaluate the relationship between paced QTc interval and mortality. Of 1440 patients who underwent pacemaker implantation from Jan 1990 ...
Geva Tal T Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA, USA. Electronic address: - - 2014
Atrial septal defects are the third most common type of congenital heart disease. Included in this group of malformations are several types of atrial communications that allow shunting of blood between the systemic and the pulmonary circulations. Most children with isolated atrial septal defects are free of symptoms, but the ...
Shin Sun-Hye SH Research Institute of Pharmaceutical Sciences, College of Pharmacy, School of Life Sciences and Biotechnology, College of Natural Sciences, Kyungpook National University, Daegu 702-701, - - 2014
Thymosin beta4 (TB4) has multiple functions in cellular response in processes as diverse as embryonic organ development and the pathogeneses of disease, especially those associated with cardiac coronary vessels. However, the specific roles played by TB4 during heart valve development in vertebrates are largely unknown. Here, we identified a novel ...
Lai Chao-Hung CH Graduate Institute of Aging Medicine, China Medical University, Taichung, Taiwan; Division of Cardiology, Department of Internal Medicine, Armed Force Taichung General Hospital, Taichung, - - 2014
Exposure to tobacco smoke has epidemiologically been linked to the occurrence of cardiovascular disease among nonsmokers but the associated molecular events are not well elucidated yet. When Sprague Dawley rats were exposed to second-hand tobacco cigarette smoke twice a day for a 30 days period at an exposure rate of ...
Facchini Emanuela E Clinical Cardiology, Department of Translational Medicine, Azienda Ospedaliero Universitaria "Maggiore della Carità", Università del Piemonte Orientale, Corso Mazzini 18, 28100, Novara, - - 2014
Conflicting data exist about the effects of cardiac resynchronization therapy (CRT) on diastolic function (DF). Aim of the study was to assess if and how CRT affects DF in systolic heart failure patients. We also investigated potential relations between CRT-induced left ventricular changes and the composite clinical endpoint of progressive ...
Silva Etelvino E Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, - - 2014
There is extensive controversy exists on whether cardiac resynchronization therapy corrects electrical or mechanical asynchrony. The aim of this study was to determine if there is a correlation between electrical and mechanical sequences and if myocardial scar has any relevant impact. Six patients with normal left ventricular function and 12 ...
Yang Kai-Chien KC Lifespan Cardiovascular Institute, the Providence VA Medical Center, and Brown University, - - 2014
Mitochondria are essential to providing ATP thereby satisfying the energy demand of the incessant electrical activity and contractile action of cardiac muscle. Emerging evidence indicates that mitochondrial dysfunction can adversely impact cardiac electrical functioning by impairing the intracellular ion homeostasis and membrane excitability through reduced ATP production and excessive reactive ...
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